The Mental Deficiency Services Today and Tomorrow *A talk given to the Mental Deficiency Section of the Royal Medico-Psychological Association at their Annual General Meeting, 16th July, 1954.

care and training of high grade mental defectives could not be better carried out within the framework of the general social services rather than through a special mental deficiency service. I shall try to show very briefly how I think this could be accomplished, and why I favour the contraction rather than the expansion of the mental deficiency services. First, then, to whom do the mental deficiency laws apply? In the 19th century and until the passing of the 1913 Mental Deficiency Act the only defectives recognised in law were the idiots and imbeciles. In 1913 a new class of defectives, the feebleminded, was created. Now while the terms "idiot" and "imbecile" have a well understood medical implication, the meaning of which is unequivocal, the term feeble-minded has a social implication and its meaning is a good deal more vague. I think however that when it was first introduced, and until fairly recently, it was assumed that a fundamental, and necessary (though not sufficient) feature of feeble-mindedness was a gross subnormality in intelligence. Thus Dr. E. O. Lewis, for example, whose authority in this matter cannot be challenged, began his Presidential Address to the Section of Psychiatry of the Royal Society of Medicine in 1950 by saying that "the concept the lay person in this country has of mental defect applies with few exceptions to individuals with intelligence quotients below 60 per cent?that is idiots, imbeciles and obvious simpletons." This concept, he added, "corresponds fairly closely to the legal interpretation of the mental deficiency acts in this country." To say this is not to imply that subnormality of intelligence is the only characteristic of mental deficiency. But it is, according to this view, a necessary one. The Wood Committee in making its recommendations used as its criteria the standards set up by Dr. Lewis; and on this basis it concluded that institutional care was required for about 110,000